个性化多焦点人工晶状体植入术的初步临床研究

Comparative assessment of individualized multifocal intraocular lens implantation

目的探讨超声乳化白内障吸除联合双眼分别植入衍射型与折射型多焦点人工晶状体（MIOL）术后的视觉质量，评价Custom Match个性化搭配模式的可行性。方法前瞻性研究。将年龄相关性白内障患者分为MIOL组与单焦点人工晶状体（SIOL）组各10例，行超声乳化白内障吸除联合人工晶状体（IOL）植入术。MIOL组为主视眼植入ReZoom NXG1 IOL，对侧眼植入Tecnis ZM900 IOL；SIOL组为同期双眼植入Sensar AR40e IOL。观察患者术后不同光照条件下的远、中、近距离视力、阅读视力和阅读速度、焦点深度以及问卷调查。采用析因设计的方差分析，两两比较采用LSD检验。结果术后1个月观察发现，在100cd／m^2和6cd／m^2光照度下，MIOL组患者可获得满意的双眼裸眼远视力和最佳矫正远视力。100cd／m^2时，MIOL组在40cm、63cm和100cm的裸眼视力均在0．63以上，显著高于SIOL组（P=0．000）；6cd／m^2时，MIOL组在100cm时的双眼裸眼视力与SIOL组比较差异无统计学意义（P=0．360），在63cm和40cm时显著高于SIOL组（P=0．000）。在明、暗光线下MIOL组患者的裸眼阅读视力和阅读速度显著高于SIOL组（P=0．000，0．000），与SIOL组矫正后的阅读能力比较，差异没有统计学意义。MIOL组的焦点深度可达5．5D，其在中、近距离工作和阅读时的脱镜率可达70％（7／10）。结论Custom Match个性化搭配模式在一定范围内可给白内障术后患者提供良好的全程视力。

Objective To evaluate the visual quality after combined implantation of refractive and diffractive multifocal intraocular lens （MIOLs） in both eyes （CustomMatch pattern ）. Methods Prospective, nonrandomized study. Zhongshan Ophthalmic Center, Sun yat-sen university, P. R. China. Age-related cataract patients, selected according to the inclusion criteria and divided into MIOL group and monofoeal intraocular lens （SIOL） group, received phacoemulsification and were implanted with combined a ReZoom NXG1 IOL in the dominant eye and a Tecnis ZM900 IOL in the fellow eye or bilateral Sensar AR40e IOLs. Monocular and binocular testing one month after surgery included uncorrected and best-spectacle corrected visual acuity at far, intermediate and near distances under 100 cd/m^2 and 6 cd/m^2 , reading visual acuity and reading speed, defocus curve, and subjective vision-related quality of life using questionnaire. Results Under 100 cd/m^2 and 6 cd/m^2 , binocular mean uncorrected visual acuity at 500 cm in MIOL group was logMAR 0. 013 ± 0. 149 and logMAR 0. 163±0. 220 and binocular mean best-spectacle corrected visual acuity was logMAR -0. 027 ± 0. 092 and logMAR 0. 109 ± 0. 175 respectively. The mean refraction spherical equivalent for best distance corrected visual acuity was （ - 0. 18 ±0. 85 ） D and （ - 0. 32 ±0. 90 ） D respectively. Under 100 cd/m^2, better uncorrected visual acuity （ decimal 0. 63） at 40cm, 63 cm and 100 cm was achieved in MIOL group. Under 6 cd/m^2 , the uncorrected visual acuities in MIOL group at 40 cm and 63 cm distance were significantly higher than those in SIOL group although there were no statistically difference at 100 cm. Uncorrected reading visual acuity and reading speed in MIOL group were better than those in SIOL group, while the results in reading ability were similar when MIOL group without correction compared with SIOL group with correction. The depth of focus was 5.5 diopter in MIOL group. No patient in both groups wore glasses for distance and 70% patients in MIOL group did not need to wear glasses for intermediate and near distances after surgery. Conclusion CustomMatch pattern could provide a satisfactory vision at a full range of near, intermediate and far distance and improve the life quality to a certain extent.